Provider Demographics
NPI:1790374700
Name:KAPPELER, MIRANDA JEAN
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:JEAN
Last Name:KAPPELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 PEAKS MILL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8865
Mailing Address - Country:US
Mailing Address - Phone:606-521-8980
Mailing Address - Fax:
Practice Address - Street 1:3050 RIO DOSA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1540
Practice Address - Country:US
Practice Address - Phone:869-269-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health